What are the barriers and facilitators to seeking help for mental health in NHS doctors: a systematic review and qualitative study

The effect of the COVID-19 pandemic on the mental health of obstetrics and gynaecology trainees: a world-wide literature review

BACKGROUND

Coronavirus (COVID-19) pandemic has affected the training and wellbeing of obstetrics and gynaecology (O&G) trainees. The aim of this review is to offer a worldwide overview on its' impact on the mental health of O&G trainees, so that measures can be put into place to better support trainees during the transition back to the 'new normal'.

METHODS

Key search terms used on PubMed and Google Scholar databases include: mental health, COVID-19, O&G, trainees, residents.

RESULTS

Fifteen articles (cumulative number of respondents = 3230) were identified, of which eight employed validated questionnaires (n = 1807 respondents), while non-validated questionnaires were used in seven (n = 1423 respondents). Studies showed that COVID-19 appeared to exert more of a negative impact on females and on senior trainees' mental health, while protective factors included marriage/partner and having had children. Validated and non-validated questionnaires suggested that trainees were exposed to high levels of anxiety and depression. Their mental health was also affected by insomnia, stress, burnout and fear of passing on the virus.

DISCUSSION

This review analyses the global impact of COVID-19 on O&G trainees' mental health, showing a pervasive negative effect linked to fear of the virus. Limited psychological support has led to prolonged issues, hindering patient safety and increasing sick leave. The study underscores the urgency of comprehensive support, particularly in female-dominated fields. Addressing these challenges is crucial for future pandemics, highlighting the need to learn from past mistakes and prioritise mental health resources for trainee well-being during and beyond pandemics.

'Do I cry or just carry on?' A story completion study of healthcare professionals' anticipated responses to experiencing chest pain

Healthcare professionals may experience barriers to seeking healthcare that differ from the general population. We explored healthcare professionals' anticipated responses to experiencing chest pain following a period of stress using qualitative story completion method with healthcare professionals (n = 44). Data were analysed using reflexive thematic analysis, which identified three themes: '"Do I cry or just carry on?": A Culture of Suffering in Silence' identified worries that expressing health concerns would be perceived as weakness, with potential impact on career opportunities. Participants also described self-diagnosis and self-medication rather than help-seeking. '"Me? Have a panic attack?": Psychosomatic Shame' suggested mental health issues may be ignored due to stigma. '"We definitely don't take care of ourselves": Prioritising Pressures of Multiple Responsibilities over Self-care' identified real or perceived pressures to de-prioritise their health. Future research should explore the design of confidential, time efficient support for healthcare professionals that tackle cultural norms and barriers to self-care.

Common stressors, coping processes, and professional help-seeking of medical professionals in Hong Kong: A qualitative study

Despite the high prevalence of perceived stress and mental health problems among medical professionals (MPs), their professional help-seeking is extremely low. This qualitative study explored MPs' stressors, stress-coping, barriers and facilitators of professional help-seeking. 10 MPs (30% male, Mage = 34.8 years) were recruited by purposive-sampling for views from different roles/settings. Thematic analyses revealed five central stressors: emerging novel diseases, challenges from technology-advancement, patient-communication difficulties, lack of workplace mental health care culture, excessive workload/manpower shortage. Participants predominantly used peer support/supervision and de-stress activities for stress-coping. Five factors affecting professional help-seeking were time constraint versus flexibility, mental health stigma versus de-stigmatization, concern over confidentiality/anonymity versus sense of privacy, worry about damage on professional role versus least work disruption, doubts of service providers versus perceived efficacy. All participants indicated a preference for online mental health service delivery. Results reflected unmet needs and service gaps from MPs' perspectives for the development of future interventions.

A service mapping exercise of four health and social care staff mental health and wellbeing services, Resilience Hubs, to describe health service provision and interventions

BACKGROUND

NHS England funded 40 Mental Health and Wellbeing Hubs to support health and social care staff affected by the COVID-19 pandemic. We aimed to document variations in how national guidance was adapted to the local contexts of four Hubs in the North of England.

METHODS

We used a modified version of Price's (2019) service mapping methodology. Service level data were used to inform the analysis. A mapping template was adapted from a range of tools, including the European Service Mapping Schedule, and reviewed by Hub leads. Key data included service model; staffing; and interventions. Data were collected between March 2021 - March 2022 by site research assistants. Findings were accuracy-checked by Hub leads, and a logic model developed to theorise how the Hubs may effect change.

RESULTS

Hub goals and service models closely reflected guidance; offering: proactive outreach; team-based support; clinical assessment; onward referral, and rapid access to mental health support (in-house and external). Implementation reflected a service context of a client group with high mental health need, and high waiting times at external mental health services. Hubs were predominantly staffed by experienced clinicians, to manage these mental health presentations and organisational working. Formulation-based psychological assessment and the provision of direct therapy were not core functions of the NHS England model, however all Hubs incorporated these adaptations into their service models in response to local contexts, such as extensive waiting lists within external services, and/or client presentations falling between gaps in existing service provision. Finally, a standalone clinical records system was seen as important to reassure Hub users of confidentiality. Other more nuanced variation depended on localised contexts.

CONCLUSION

This study provides a map for setting up services, emphasising early understandings of how new services will integrate within existing systems. Local and regional contexts led to variation in service configuration. Whilst additional Hub functions are supported by available literature, further research is needed to determine whether these functions should comprise essential components of staff wellbeing services moving forward. Future research should also determine the comparative effectiveness of service components, and the limits of permissible variation.

STUDY REGISTRATION

researchregistry6303.

'Who you gonna call?' A qualitative study of psychiatrists accessing mental health services

OBJECTIVE

To identify motivation, capabilities and opportunities that enable psychiatrists and registrars to seek help for mental health problems and to inform design of interventions.

METHOD

Data collected in qualitative semi-structured interviews were analysed using a framework approach with the COM-B model of behaviour as a theoretical frame.

RESULTS

Accounts of the eight participants show help-seeking to be a complex process requiring cognitive and emotional capability to recognise a problem or goal, acceptance of vulnerability, and facilitated by access to professional networks. Help-seeking was enabled by openness about mental health problems in workplace culture.

CONCLUSIONS

Interventions to enable help-seeking should focus on normalising the experience of mental health problems among doctors and challenge the notion that difficulties represent characterological flaws. Greater understanding of the mandatory reporting requirements is also required.

Factors associated with burnout among healthcare providers in a rural context, South Africa

BACKGROUND

 Healthcare providers (HCPs) are at risk of burnout in sub-Saharan Africa. However, there is little research in rural and primary care settings.

AIM

 To evaluate burnout and its associated factors among public sector HCPs in South Africa.

SETTING

 Primary health care clinics, community health centres and district hospitals in Nkomazi Local Municipality, Mpumalanga province.

METHODS

 Quantitative study design using a cross-sectional survey. Healthcare providers (n = 1139) working in Nkomazi Local Municipality were invited to participate. Burnout was assessed using the Maslach Burnout Inventory. A demographic and occupational questionnaire, the General Help-Seeking Questionnaire and the Health and Safety Executive Indicator Tool were used.

RESULTS

 A total of 302 HCPs, between 23 and 61 years, mostly female (n = 252; 83.44%) and nurses (n = 235; 77.81%) participated. High burnout was observed for Emotional Exhaustion (median score 26 [IQR {interquartile range}: 34-16]) and Personal Accomplishment (median score 29 [IQR: 34-25]). Most participants (n = 215; 71.19%) would seek help if they had an emotional problem. Bivariate analysis revealed significant associations between workplace demands, control, management support, peer support, relationships, role and change with all subscales of burnout. Multivariate regression analysis found that Personal Accomplishment improved by 0.49 (95% CI: 0.10-0.89) for every point in improved work demands, by 0.84 (95% CI: 0.01-1.67) for every point towards improved management support and by 1.19 (95% CI: 0.48-1.90) for every point towards having an improved role.

CONCLUSIONS

 During 2022, HCPs working in a rural area in South Africa displayed high levels of burnout for Emotional Exhaustion and Personal Accomplishment but not for Depersonalisation.Contributions: Improvements in work demands, managerial support and role clarity may reduce burnout among HCP in a rural, primary care setting.

Psychological Attitudes of Physicians in Seeking Help and Associated Factors

Background

Physician suicides have been increasing in recent years, and this shows that the psychological state of physicians is a subject that needs research and intervention. We think that the factors affecting the behavior of physicians to seek medical help due to their psychiatric disorders should be addressed. Therefore, we conducted a study examining the relationship between the anxiety, depression and stress levels of physicians, their attitudes toward seeking psychological help, and the degree of self-stigma related to seeking help.

Methods

One hundred sixty-six physicians who accessed online platforms were included in the study, and data were collected using self-report forms. The Depression Anxiety Stress Scale, the Attitudes Toward Seeking Professional Psychological Help Scale, and the Self-Stigma in Seeking Help Scale were used as assessment instruments.

Results

A positive correlation was found between negative attitudes toward seeking psychological help and depression, anxiety, and stress, whereas a negative association was found between positive attitudes and depression, anxiety, and stress. A significant association was found between age and depression and anxiety scores.

Conclusion

Physicians with high levels of depression, anxiety, and stress are more likely to exhibit negative attitudes toward seeking psychological help, and interventions are needed to improve attitudes toward seeking help.

Patient Safety and Clinician Well-Being

Clinician well-being and patient safety are intricately linked. We propose that organizational factors (ie, elements of the perioperative work environment and culture) affect both, as opposed to a bidirectional causal relationship. Threats to patient safety and clinician well-being include clinician mental health issues, negative work environments, poor teamwork and communication, and staffing shortages. Opportunities to mitigate these threats include the normalization of mental health care, peer support, psychological safety, just culture, teamwork and communication training, and creative staffing approaches.

PA access to provider health programs

OBJECTIVE

This study assessed the availability of provider health programs (PHPs) for physician associates/assistants (PAs), as well as the accessibility of information about these resources through state licensing boards and PA constituent organizations.

METHODS

Data were collected through audits of the websites of the PA licensing board and state/district constituent group for each state and the District of Columbia from October to November 2022.

RESULTS

Every state except Massachusetts has a PHP that serves PAs. Review of the 51 respective state licensing board websites revealed that 23 states (45.1%) list PHP information; only 9 states (17.6%) have PHP information listed on state PA constituent organization websites.

CONCLUSIONS

The results of this study indicate that PHPs for PAs are widely available. Unfortunately, the broad availability of PHPs may be limited by the lack of accessible information about these programs in many states.

Attitudes and intentions toward seeking professional psychological help among Chinese healthcare workers during the COVID-19 pandemic

Background

It has been suggested that healthcare workers (HCWs) are experiencing massive stressors that threaten their mental health during the COVID-19 pandemic, but little is known about their attitudes and intentions toward seeking professional psychological help. This study aimed to investigate the attitudes and intentions of Chinese HCWs toward seeking professional psychological help during the COVID-19 pandemic and the associated factors.

Methods

A total of 1,224 Chinese HCWs working in hospitals were recruited online from 12 hospitals in Hunan province in China for a survey conducted in November 2022. The Chinese version of the attitudes toward seeking professional psychological help scale-short form (ATSPPH-SF) and the general help-seeking questionnaire (GHSQ) were separately used to assess the attitudes and intentions of the respondents toward seeking professional psychological help. Demographic and socio-psychological data were collected using a self-developed questionnaire, the perceived social support scale, the self-stigma of seeking help scale, and the patient health questionnaire-9 scale.

Results

The 1,208 HCWs in the final analysis showed relatively negative attitudes and low intentions toward seeking professional psychological help during the COVID-19 pandemic. Results of the multiple linear regression analysis showed that female sex (p = 0.031), experience of psychological learning (p < 0.001), and social support (p < 0.001) had a positive predictive effect on the attitudes of these HCWs toward seeking professional psychological help, whereas self-stigma of seeking help (p < 0.001) and depressive symptoms (p < 0.001) exerted negative effects. Moreover, experience of psychological learning (p = 0.004) and social support (p < 0.001) had a positive predictive effect on the intentions of these HCWs toward seeking professional psychological help, whereas divorced marital status (p = 0.011) and self-stigma of seeking help (p < 0.001) exerted negative effects.

Conclusion

The overall attitudes and intentions of HCWs toward seeking professional psychological help were not optimistic. Effective interventions targeted at influencing factors should be formulated to promote the professional psychological help-seeking attitudes and intentions of HCWs who are at risk of developing mental health problems.

Translation, Adaptation, and Validation of the Malay Version of the Barriers to Access to Care Questionnaire for Assessing the Barriers to Seeking Mental Health Care Among the Health Workforce in the East Coast Region of Peninsular Malaysia

Background Mental health problems among the health workforce are a significant concern worldwide, including in Malaysia. Unfortunately, some health workforce may perceive various barriers or challenges that prevent them from seeking help. Identifying and addressing these barriers is crucial for enhancing mental health services and support. The Barriers to Access to Care Evaluation (BACE-3) questionnaire is a valuable tool that can be used for assessing these barriers among health workers. However, a validated Malay version is needed. Therefore, this study aims to translate, adapt, and validate the original version of Barriers to Access to Care Evaluation (BACE-3) into the Malay version (MBACE). Methods A rigorous process of translation and adaptation was followed to develop the Malay version of the BACE-3 questionnaire (MBACE). A cross-sectional study was conducted to assess the psychometric properties of the questionnaire, with purposive sampling employed to recruit 188 participants from various job categories, including doctors, nurses, pharmacists, and non-clinical staff, such as health assistants and clerks. The analysis was conducted using the R software version 4.2.2 (R Foundation, Vienna, Austria). Construct validity was determined using confirmatory factor analysis (CFA). To assess the convergent validity, internal consistency, and reliability of the instrument, measures such as the average variance extracted (AVE), composite reliability (CR), and Cronbach's alpha values were calculated. Results During the CFA process, two items with a factor loading less than 0.5 (items 15 and 16) were removed to improve the convergent validity and model fit. The CFA results revealed that the 2-factor model MBACE had good construct validity (root mean square error of approximation (RMSEA) = 0.053; comparative fit index (CFI) = 0.939; Tucker-Lewis fit index (TLI) = 0.934). The internal consistency was supported by Cronbach's alpha values ranging from 0.92 to 0.94 for the stigma factor and non-stigma factor. The average variance extracted (AVE) and composite reliability (CR) values further supported the questionnaire's reliability and convergent validity. Conclusion The translated and adapted 28-item MBACE questionnaire is a valid and reliable tool for assessing the barrier to seeking professional mental health care among the Malaysian health workforce. This instrument has the potential to aid in the development of targeted interventions to promote mental health help-seeking behavior and enhance the well-being of the Malaysian health workforce.